What is Robotic Heart Surgery and Robotic Mitral Valve Surgery All About?

Robotic heart surgeons operate from a console next to the patient and control the tiny robotic instruments.

What is robotic heart surgery? Traditional heart surgery is performed by dividing the breastplate with a saw (sternotomy). Robotic heart surgery is a form of minimally invasive heart surgery that allows a surgeon and their team to use dexterous robotic instruments and a robotic high-definition 3D camera to perform precision surgery through tiny incisions.Avoiding open surgery may lead to faster recovery.The surgeon sits next to the patient and controls the robot.

Although results vary for individuals, the endoscopic robotic approach may allow patients to return to normal activity faster than with sternotomy! An example of a commonly performed robotic operation that we perform is totally endoscopic robotic mitral valve repair. The robotic system is particularly useful for this problem as it allows for excellent visualization for mitral valve repair.

Recent robotic mitral valve repair patient playing golf 2 weeks after surgery! Recovery time varies but this shows what is possible. Posted with permission of the patient.

Robotic instruments have the same dexterity and range of motion of a surgeon’s hands but are much smaller (maximum of 8 mm in diameter). Also, the robotic system helps to smooth out the surgeon’s hand and finger motion by using a “fly by wire” type of approach similar to that used in modern jet aircraft. In other words, things like a tremor can affect the movements of a surgeon’s hand, however these types of unwanted movements are eliminated by the use of the robotic system. Additionally, the ability to precisely control the high definition 3D camera of the robotic system and steer it easily into position along with a small robot-controlled surgical retractor allows for excellent visualization.

Precision Robotic Surgical Procedures Require a Team Approach and Experience

To perform robotic heart surgery, a highly trained and experienced surgeon and equally experienced team is required. Just like a pit crew in racing, this team must function together flawlessly to achieve a high level of performance. With robotics, the surgeon sits at a console in the operating room controlling the instruments while looking at a high-definition 3D image from the camera inside the patient. The surgeon controls the robot at all times. It does not do anything without the surgeon directing it (just as a pilot controls an airplane).

Mitral valve repair is particularly amenable to the robotic approach because the mitral valve is inside a small chamber in the heart (the left atrium) and is most easily seen from the right side of the chest. The robotic system allows the surgery to navigate into this small space and see clearly because of the high definition robotic camera. Also, the extreme dexterity and freedom of movement of the robotic instruments allows the surgeon to perform complex mitral valve repair techniques.

Animation of Robotic Mitral Valve Repair Surgery

The most important factors in selecting a center for robotic heart surgery is training and experience. Recent media reports have expressed appropriate concern over the safety of robotics by surgeons and teams that are inadequately trained and prepared for these advanced procedures. I have spent over a decade focusing on mastering robotic surgery gaining enormous) experience at every level including extensive formal and informal robotic cardiac surgery.

Another issue to be aware of is that many hospitals and surgeons claim to do robotic heart surgery, but very few are doing it routinely and exclusively through tiny incisions. I mostly do what I consider to be totally endoscopic procedures, which I define as: the incisions being so small (usually 8-15 mm) that you cannot see into the chest directly to do any portion of the procedure. For totally endoscopic robotic mitral valve repair, the large largest incision that I make in the chest is only 15mm, about the diameter of a finger!

Keep in mind, that depending on what their problem is, most patients undergoing heart surgery will still need a standard incision. However, many heart surgery procedures are easily performed with the robot. Also understand that there are many different techniques and methods to repair your mitral valve. There are many excellent surgeons who use alternative techniques with great results (such as sternotomy, mini-sternotomy, “port access” mini-thoracotomy, and others).

Dr. Guy performing a mitral valve repair with the Da Vinci® Robot

That being said, I sincerely believe in robotic cardiac surgery for an appropriate patient because it allows me to make truly tiny incisions to do the operation, avoid a sternotomy (sawing open the breastplate), and see and repair the mitral valve with great clarity and precision.

The purpose of this website is to provide you with detailed information about robotic cardiac surgery from a surgeon who does it and empower you so that you can make informed choices about your medical care. Ultimately the decisions are yours. I want to make sure you are able to make informed decisions and truly understand your options.

Dr. Guy earned his MD and completed surgery residency and cardiothoracic surgery fellowship at the University of Pennsylvania. He has extensive training and experience in robotic cardiac surgery. He is a former Lieutenant Colonel in U.S. Army who served 3 tours as a combat surgeon in Iraq and Afghanistan. He is an Associate Professor of Cardiothoracic Surgery and Director of Robotic Cardiac Surgery at Weill Cornell Medicine and NewYork-Presbyterian Hospital in New York City.

Summary of Dr. Guy’s Background

EDUCATIONWake Forest University, BS, 1989 Wharton School of Business, MBA, 1992 University of Pennsylvania School of Medicine, MD, 1994TRAINING University of Pennsylvania Surgery Residency, 2002 University of Pennsylvania Cardiothoracic Fellowship, 2004ACADEMIC APPOINTMENTS Uniformed Services University of the Health Sciences, 1995 - 2010 UC San Francisco, 2006-2010 Temple University School of Medicine, 2011-2015 Weill Cornell Medicine, 2015-presentBOARD CERTIFICATIONS American Board of Surgery American Board of Thoracic SurgeryORGANIZATIONS American Association for Thoracic Surgery Society of Thoracic Surgeons Heart Valve Society Fellow, American College of Surgeons Fellow, American College of Cardiology International Society of Minimally Invasive Cardiothoracic Surgery 21st Century Cardiothoracic Surgery Society

Intended Audience & Mission Statement

The intended audience for this site are patients with heart conditions, their families and interested medical professionals. Its mission is to increase knowledge and awareness of robotic cardiac surgical techniques with an emphasis on patient empowerment. Many are not aware of these options and hopefully this site will increase awareness.